Telehealth as an Outreach Tool for Teen Mothers, Essay Example

Abstract

Young mothers face a number of obstacles which can affect their ability to successfully parent.  Among these are lack of schooling, difficulty finding work which corresponds with their child care needs, and the social stigma which is associated with young motherhood and poverty (Best Start, 2011).  Such barriers can increase the social isolation of young mothers, making it difficult for them to access resources to assist them in caring for their children and in dealing with their own physical and emotional needs.  The Young Mothers Outreach Program proposes to develop an online presence through the Montreal Portal which would also utilize text-messaging in order to provide outreach services and counselling to young mothers in the greater Montreal area.  This telehealth application would provide young mothers with the social connection which is often sorely lacking in their lives while also providing inclusive and non-judgemental information and referral services in an easily accessible and affordable format with the aim of eventually expanding province-wide.

Introduction

The province of Quebec has a reputation for providing excellent public health and health care resources for families, especially in the areas of child care, economic support and incentives, and early childhood education, initiatives which have contributed to a rise in the provincial birth rate (Tougas, n.d.).  However, few of these programs specifically target young mothers and their children.  While there are public health and private programs which seek to work with teens in the areas of sexual health and pregnancy prevention, there is a decided lack of availability of programs which help to broaden the social connections, educational opportunities, and support networks of young mothers.  This is not to say that these programs are totally absent; indeed, at a local level, Quebec offers a variety of drop-in centres and mother-child programs which are targeted at parents under the age of 20, such as Montreal’s Head and Hands Young Parent program (Head and Hands, 2011).  However, while young mothers are encouraged in such settings to discuss their parenting concerns with peers and counsellors, the social stigma and shame attached to issues such as alcohol and drug use, child and family violence, and poverty can make such environments inconducive to open and honest dialogues about the core issues which some young mothers face.

This proposal aims to identify the needs of young mothers in the Quebec region in order to offer an alternative means of outreach for this population through telehealth applications which may additionally complement existing in-person services.  Although telehealth offers a wide range of sophisticated applications which serve to shorten the distance between health care providers and patient populations, the allure of new and high-tech uses sometimes lead the simplest and most direct applications to be overlooked (McConigle & Mastrian, 2009).  Thus, this proposal suggests that the Internet, Smartphone applications, and Instant Messaging (IM) are viable ways to connect with young mothers in a manner which promotes privacy, confidentiality, and a mode of communication with which they are comfortable and proficient (Pierce, 2009).  Using a model which is not dissimilar from social networking sites such as Facebook, the Young Mothers Outreach program will utilize a unique and secure web portal through which users can access information, support, and resources to assist them in parenting their children and themselves.  Additional Smartphone applications will allow users to ‘chat’ in real-time with counselling staff, much in the manner which many young women currently communicate with their friends and family members (Lenhart et al., 2005).

This proposal will first provide an overview of the specific issues faced by young Canadian mothers in terms of both their relationship with their child(ren) and their individual social, emotional, and physical well-being.  A subsequent literature review will address current programs which, while not identical to the one being proposed, share some similarities which may assist in developing and implementing a successful telehealth outreach program for this population.  The literature review will also look at the behaviors of young women in relation to the Internet, Smartphone, and Instant Messaging, and will evaluate several online programs which currently provide outreach to young people through the Web.  This proposal will also provide several strategies for implementing the Young Mothers Outreach Program, including a review of potential funding sources and community partnerships and an evaluation of the ways in which the target population can best be encouraged to utilize this telehealth resource.  As well, the proposal will provide an outline of potential services which may be accessed through the web portal, as well as the benefits and limitations of counselling and health services offered through an IM format.  This proposal will also discuss potential barriers to success, including privacy issues, the possible duplication of services, and the potential for resistance in using telehealth amongst young women.  Privacy and confidentiality are especially key to the success of the Young Mothers Outreach Program, both in terms of the overall security of the telehealth format and the personal needs of young women to ensure that the services they access are ones which they can trust as entirely confidential.  Finally, this proposal will provide some insight into the potential province and nation-wide expansion of the program, with the aim of adding additional services to reach related populations such as young fathers, young couples, and the family unit.  Additionally, it will evaluate some of the future applications of IM and Smartphones as a vehicle for providing personal service to clients in a public health context.

Young Mothers in Canada and Quebec

The reason why young women become pregnant are varied, ranging from limited knowledge of or access to birth control to the desire to achieve family stability through the introduction of a child into a relationship (Best Start, 2011).  Public Health approaches to teenage mothers in Quebec have tended to take a preventative approach, recognizing that pregnancy and motherhood represents a major financial, emotional, and social commitment that many young women are unprepared to deal with.  Statistically, the incidents of pregnancy among women under the age of 20 has been declining throughout Canada since the 1970s; in 1974, 29.9 of every 1000 young women gave birth, whereas only 12 out of every 1000 Canadian teens gave birth in 2008.  These figures provide a somewhat limited view of teenage pregnancy in Canada because they only take live births into account, and do not track abortions, stillbirths, or miscarriages, all of which tend to be under-reported in teenage populations (Best Start, 2011).  The average age of mothers in Canada is 29.3, with Ontario and British Columbia reporting the highest percentage of births to mothers age 30 and over and Nunavut reporting the youngest average age of mothers nationally at 24.4.  The rate of births to teenage mothers was 8 times the national average in Nunavut, and substantially lower than the national average in Ontario, British Columbia, and Quebec.  At 8.5 per 1000 women, Quebec’s teen birthrate was the lowest in Canada in 2008 (Human Resources and Skills Development Canada, 2011).

While these numbers are incredibly encouraging from a public health perspective which encourages pregnancy prevention in young women, they can also result in a lack of services and resources for those individuals who do give birth prior to the age of 20.  For example, the number of services available for young mothers in Nunavut is much higher than in Quebec because the perceived need is so much greater (HRSDC, 2011).  Thus, there is the potential within Quebec for this specific population to fall below the radar of public awareness, leading to an increased level of risk for the statistically small number of young women who do give birth and choose to raise their child.  This is not to suggest that there are no programs for young mothers in the province of Quebec.  Indeed, Montreal, the largest urban centre in the province, has several excellent programs which are geared specifically for young mothers and their children.  For example, the Elizabeth House Foundation (2011) provides a dedicated high school, prenatal and child development classes, and job training for mothers under the age of 20.  A related program, On Our Own (2011), helps to provide young parents with access to affordable housing and childcare.  However, neither program accepts self-referrals or offers drop-in services; instead, young women must be directed to these programs through family physicians, social workers, or school counsellors, which limits access to these services to young women who are already receiving some level of help from social services regarding parenting challenges.  Similarly, residents of the greater Montreal area have access to a number of parenting programs through local community centres and religious organizations.  Many of these, such as the Head and Hands (2011) program and the Public Health Agency of Canada’s ‘Nobody’s Perfect’ (2011) program are meant to educate and support young parents who face a number of social and economic factors which may impede their ability to successfully parent.

However, although access to these programs are free of charge and voluntarily, they are also reliant on a teen’s ability to both recognize that she needs help and ask for it explicitly in order to receive the necessary referral.  This can be problematic, given Pierce’s (2009) assertion that young women often lack the confidence to assert their own needs in a face-to-face environment, and are more likely than their male peers or older women to experience high levels of anxiety in social situations.  The ability of young mothers to locate and access resources is further complicated when they are seeking information or support for serious issues related to parenting.  It is much less intimidating for young mothers to search for information regarding issues such as nutrition and child development than it is for them to access resources for issues such as domestic abuse, child abuse, and substance abuse, all of which carry implicit social stigmas.  Further, by admitting that they are experiencing difficulties in these areas, young mothers also run the risk of involving social service agencies which may result in at least the perception, if not the reality, that they are increasing the risk of losing custody of their child (Best Start, 2002).  Indeed, Gregson (2009) suggest that teen mothers are often stymied both by the bureaucratic intricacies associated with seeking assistance from specific agencies and by the need to ‘prove’ themselves as competent mothers by refraining from asking for help in the first place.

According to the Government of Quebec (2001), teenage motherhood increases the likelihood that young mothers will continue with their schooling, find employment, and develop the social relationships necessary to help them cope with parenting.  The stresses of parenting without appropriate support networks can lead to substance abuse, depression, and an increased risk that the children of young mothers will experience neglect, abuse, and have their own significant adjustment problems throughout childhood and adolescence (Government of Quebec, 2001).  Many teenage mothers are themselves children of young mothers and come from disadvantaged or dysfunctional families, factors which lessen the likelihood that they will be able to find support from their own parents and extended family (Government of Quebec, 2011).  A study conducted by Trembley and colleagues (1998) of marginalized pregnant women and young mothers in the Quebec City found that the risk of negative biopsychosocial outcomes was exacerbated by their inability to access available resources, which in turn increased their sense of social isolation.  However, the ability of young mothers to successfully parent is markedly improved when their parenting practices are bolstered by family support, community support, financial stability, and the ability to access education and information (Ward and Belanger, 2010).  Such factors play a large role in offsetting the likelihood that young mothers will require long-term social assistance, will come into contact with social service agencies in a protective capacity, or will suffer from increased levels of poverty due to a lack of educational opportunities (Gregson, 2009).

Literature Review

Although young mothers often face a higher risk of negative parenting outcomes than older mothers in Quebec and the rest of Canada, research conducted by Trembley and colleagues (1998) illustrates the importance of connecting with and providing support to mothers under the age of 20.  Their project noted that although the province of Quebec provides a range of services to pregnant women and parents, few of these are targeted towards the unique needs of teenage mothers, especially those who already lack strong social and familial resources.  The research team sought to identify and connect with young mothers and pregnant girls living on the fringes of society in order to help them recognize their individual needs and strengths as young parents.  Trembley and colleagues (1998) spent 21 months working with 25 young mothers, assisting them in accessing services, breaking out of their isolation, and developing autonomous skills which would allow them to gain a greater sense of independence and confidence in both their relationship with their children and in their identification as mothers.  One of the most valuable revelations of Trembley and colleagues’ (1998) study is its recognition that the province of Quebec lacks dedicated programs which address the needs of teenage mothers, and their assertion that the most marginalized of young mothers lack the skills and initiative to access those few services which do exist.

While the growing field of telehealth research provides several studies which discuss the role that telehealth and informatics can play in connecting young people with available health services, there is a decided lack of research regarding young mothers specifically, and none at all relating to this specific proposal in terms of developing a program which will connect young mothers to support services and resources through Instant Messaging, online forums, and Smartphone applications.  However, some of the current research can be applied to this proposal by evaluating the manner in which existing telehealth programs meet (or fail to meet) the needs of young people.  As well, current research that evaluates the Internet and new technology habits of young women helps to inform the development of the Young Mothers Outreach Program proposal by illustrating that cellphone and Internet use have become pivotal means of communication for this target population.

A 2008 study conducted by Bergman and colleagues regarding the attitudes of teens and their parents to using patient health portals found that young people were generally enthusiastic at the prospect of taking control of their own healthcare access.  Indeed, young people were much more open to the idea of using the Internet as a means of communicating with health care professionals than their parents, in part due to their increased level of confidence in navigating the Internet and associated technologies.  Bergman and colleagues (2008) noted that many teens and young adults tended to forgo  accessing health care services due to fears that their privacy might be compromised, especially in sensitive areas such as sexual health and mental health services.  Given the difficulty that many teens have in discussing such areas of health care with either their parents or their family physician, Bergman and colleagues (2008) suggest that the Internet provides “a unique opportunity for confidential and secure communication between the teen and the provider” (Bergman et al., 2008).  Similarly, research conducted by Ghorbani and Heidari (2011) regarding the potential uses of the Internet as a means of improving young people’s access to and understanding of health issues found that children and adolescents can benefit from new technologies more than any other demographic population because because, unlike older generations, they have never known a world in which information was not available through these means.  Ghorbani and Heidari (2011) found that health information websites increased teens’ overall knowledge in non-controversial areas such as nutrition and personal hygiene, while also providing an alternative means of accessing information about topics that teens might not feel comfortable discussing with parents or healthcare providers such as sexually transmitted diseases, birth control, and mental health issues.  As well, Ghorbani and Heidari (2011) note that many of the surveyed teens felt more comfortable expressing their concerns regarding alcohol use, depression, and sexual activity in forums other than the traditional face-to-face counselling model, demonstrating that the Internet can provide teens with the means to both gain information and engage in communication with counsellors in areas which they perceive to be shameful or embarrassing.

The ways in which young people, especially young women, are increasingly using
online social websites, cellphone text messaging, and instant messaging to build relationships with peers illustrates how such technologies may be useful in a telehealth context to connect with socially-isolated young mothers.  Pierce’s (2009) survey of the patterns of technology use amongst high school students found that upwards of 35% of teens used cellphones, text messaging, and online social sites between 1 and 4 hours daily, with young women using these technologies much more frequently than their male counterparts.  Young women also reported a higher level of social anxiety when interacting in a face-to-face context which was offset when they were able to interact online or through text messages, environments which they perceived as safe and welcoming(Pierce, 2009).  Echoing the importance of new technologies as communicative tools for young women, Lu and colleagues (2010) note that telehealth can effectively be employed to improve the prenatal outcomes of women through an increase in consumer awareness.  Noting that text messaging is increasingly accessible and popular for women aged 15 to 24, the authors suggest that this technology “has many benefits over other modes of communication, including being low cost, easy and convenient to use, and highly accessible and popular, especially among younger women aged 15 to 24” (Lu et al., 2010, p.206).  This ease of access would be instrumental to ensuring the Young Mother Outreach Program’s success, for although not every teen mother may have access to a secure computer in which to pursue further education or social communications, cellphones are an inexpensive and private alternative to other modes of technology.

Implementation Strategies

Working in conjunction with the Montreal Office of Public Health and the Agency for Health and Social Services, the Young Mother Outreach Program would be able to build its unique telehealth service using a preexisting web portal.  The Montreal Health portal (Government of Quebec, 2011) brings together several local agencies with the goal of providing preventative health information to allow healthcare consumers to maximize local and provincial health services.  The portal already promotes texting as a way for Montreal-area residents to access information when they are trying to determine whether they need to visit the emergency room or not.  Interestingly, there currently exists a major information gap in the Montreal portal:  the site offers health and wellness information for teens and health information for pregnant women, yet provides no cross-over between these two populations.  The portal directs pregnant women to resources concerning the termination of unwanted pregnancies and adoption resources, but carries no corresponding information for mothers who wish to keep their children but find themselves needing additional resources, let alone for teen mothers experiencing hardship (Government of Quebec, 2011).

The Young Mother Outreach Program would model itself after several existing programs which can be located on the Internet.  Although text messaging has only been used, thus far, in a limited capacity as a means of delivering health information and referrals, the SEXINFO program in San Francisco, California illustrates the manner in which this delivery method can reach young people (Lu et al., 2010).  First implemented in 2008 by the San Francisco Department of Public Health, the program aimed to increase youth awareness of sexual health issues in response to a rising rate of gonorrhoea in African American adolescents.  Consumers can text a variety of codes corresponding to specific health concerns including contraceptives, pregnancy, and sexual identity, to which they receive a scripted response containing basic health information and further contact information (Levine, 2008).  Although this particular service does not address the concerns of young mothers specifically, it demonstrates the effectiveness of new technologies in reaching at-risk and hard-to-reach populations to change health behaviors (Lu et al., 2010).

A similarly effective way of reaching youth populations is demonstrated through Canada’s Kid’s Help Phone, a telephone and Internet service which provides information and counselling to children and adolescents.  The online portion of the Kid’s Help Phone utilizes message boards as a way of beginning a conversation about issues such as sexual activity, pregnancy, and relationships between young people and a team of trained counsellors (Kid’s Help Line, 2011).  Unlike the SEXINFO program, the Kid’s Help Phone provides detailed and specific responses to individual questions while encouraging message posters to telephone their anonymous 800-number in order to receive more specific counselling.  A service such as the Kid’s Help Phone could be translated specifically to young mothers through the Young Mother Outreach Program by combining text messaging with one-on-one counselling services so that the individual encounters would take on the tone of a ‘conversation’ not dissimilar from those which young people currently engage in when employing text messaging with their peers.

Finally, the Young Mothers Outreach Program would build its objectives and overall attitude using a model currently employed by the Young Mommies Homesite, a web site that was established in 1999 by a young mother in response to her perceived lack of quality information concerning both the difficulties and benefits of her status as a young mother.  Noting that many of the websites available concerning young motherhood had an inherently negative attitude, site founder Kris Cormier sought to create an inclusive, non-judgemental, and safe place for young mothers to access information and support services.  The site’s mandate is to “support, inform, and connect young mothers so they can better face the challenges of parenting” (Young Mommies, 2011) through online message boards, a pen pal program, and a strong commitment to taking a pro-child stance which supports the choice of young mothers to successfully parent their children.

Thus, the development and implementation of the Young Mothers Outreach Program would combine the positive attitude and emphasis on making a personal connection of the Young Mommies Homesite with the ease of access and delivery found at the Kid’s Help Phone website and the SEXINFO text messaging program in order to provide a text-message based program which would seek to begin a dialogue between counsellors and young mothers on a variety of sensitive issues.  Potential funding sources might include the Government of Quebec, national funding agencies, and private, community-based funding sources.  Although this program is initially targeted at the Montreal area, it would not be difficult to expand it province-wide should it prove successful.  Additionally, the SEXINFO program in San Francisco illustrates the variety of ways in which a target population can be reached in order to secure their involvement in the available service.  For example, when first promoting the SEXINFO program, the San Francisco Department of Public Health advertised banner ads on Yahoo for two weeks and utilized social networking sites such as Facebook for additional exposure.  At the local level, they also used bus shelter ads and had volunteers hand out flyers in strategic neighbourhoods that they had identified as having a high population of at-risk youth who might benefit from accessing the service (Levine, 2008).

Potential Barriers and Future Considerations

Gregson (2009) notes that young mothers are particularly sensitive to the manner in which their parenting skills are perceived by their peers, family members, and the greater society.  Because a great deal of media attention is given to instances where young mothers fail to provide their children with appropriate care, and because many of the existing resources for young people regarding motherhood and pregnancy tend to emphasize the negative outcomes of teen motherhood, many young mothers are reluctant to seek out help (Ward & Belanger, 2010).  Thus, it is vital that the Young Mothers Outreach Program situate itself as a secure, confidential, and respectful source for information and counselling services in order to deal with the fears of potential users that their comments and concerns might be used to call into question their overall fitness as mothers.  The Kids Help Phone (2011) provides its users with a detailed overview of how to clear their browsing histories in order to protect the users privacy when using public or shared computers.  In such a way, the web portal component of the Young Mothers Outreach Program could provide similar information concerning the security of text messages and steps that users can take to ensure that their anonymity remains intact.

Additionally, Finn and Banach (2000) suggest that any programs which use counselling in tandem with the Internet and new technologies need to be especially careful to ensure the safety of target users.  This could be addressed by providing clarity in regards to the credentials of all counselors, information regarding the affiliation (government or otherwise) of the project, and concrete information for counsellors and volunteers regarding ethical approaches to counselling in a text-messaging format (Finn & Banach, 2000).

The Young Mothers Outreach Program has the potential to empower and inform young women who might otherwise remain marginalized and isolated.  While not meant to replace face-to-face communications, this telehealth program could effectively supplement existing programs while providing young mothers with the self-confidence necessary to access resources within the community.  Additionally, the text-messaging component of the Young Mothers Outreach Program will provide young women with anonymous counselling services aimed to help them cope with the internal and external stresses associated with young motherhood.  Although this proposal is specifically aimed at young mothers under the age of 20, there is the potential to expand this program to include the unique needs of young fathers who also must deal with a host of specific pressures and fears in attempting to successfully parent their children.

References

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